The Ombudsman Column

The Back Story at Frontline

By Michael Getler

April 9, 2009

Last week's Ombudsman's Mailbag included a segment on the March 31 broadcast of "Sick Around America" on PBS's flagship documentary series, Frontline. The program dealt with health care in this country and the letters to me were uniformly critical of the program's failure to discuss, or even mention, or interview an advocate for what is called the "single-payer system" of national health insurance as a potential solution to the nation's health care crisis. The column also included Frontline's response to this criticism.

Well, the criticism didn't stop there. It escalated and then exploded, producing another round of critical mail and a serious journalistic dispute. To understand this, you need to first have the equivalent of a theater's Playbill with a cast of characters.

In Order of Their Appearance

First, there is the single-payer system. This describes a system in which there is a single payer, or source of money, to pay doctors, hospitals and other health care providers. That source is usually the government, as in systems in Australia and Canada, and the Medicare system for seniors in the U.S. Advocates believe this is a good way to deliver universal health care and that it has many advantages. A bill (H.R. 676) proposing this, with more than 60 co-sponsors, has been introduced in the House of Representatives. Opinion polls suggest it has a fair amount of support, but the Obama administration does not appear to favor it.

Second, there is Russell Mokhiber. He is editor of the Corporate Crime Reporter, a newsletter that appears both in print and online. On April 2, he wrote an online column on that site headlined "Something Is Rotten at PBS" that was sharply critical of Frontline's broadcast. Mokhiber's article was picked up by several other Web sites, among them CounterPunch, Crooks and Liars and Atheo News. It was Mokhiber's article that provoked much of the follow-up criticism and mail.

Mokhiber was identified on those Web sites and others as editor of the Corporate Crime Reporter. But he is also an activist and founder of an organization known as Single Payer Action, which describes itself as a "national non-profit . . . seeking to implement a single-payer health insurance system in the United States," a "Medicare for all" style program.

Mokhiber's article attacking Frontline did appear on the Single Payer Action site, but without a full byline. Some other sites that picked up the article, such as Common Dreams and OpEdNews, did identify him with both organizations. I mention this because a number of sites that used or referred to the article did not call attention to his association with the advocacy group.

Next comes the man who wasn't there, T. R. Reid. Here, I pause for a bit of full disclosure. Reid is a friend and former colleague at The Washington Post. Reid is a reporter and author who also, in recent years, has focused on the health care issue and has done two previous films with Frontline, "A Second Opinion" and "Sick Around the World," which was the precursor to the current production and which emphasized that several major countries outside the U.S. with good health care coverage did not allow for-profit health insurance companies to sell basic medical coverage. He had also been working on "Sick Around America."

But Mokhiber, aside from criticizing the Frontline program, also reported that Reid "was cut out of the film when it aired this week," even though "Reid did the reporting for the film." Mokhiber wrote that the film "didn't present Reid's bottom line for health care reform — don't let health insurance companies profit from selling basic health insurance . . . Instead, the film that aired Monday pushed the view that Americans be required to purchase health insurance from for-profit companies."

Mokhiber accused Frontline of having "a deceptive segment [involving an interview with Karen Ignagni, president of America's Health Insurance Plans] that totally got wrong the lesson of Reid's previous documentary." Other countries do not require citizens buy health insurance from for-profit health insurance companies, Mokhiber wrote. "In some countries like Germany and Japan, citizens are required to buy health insurance, but from non-profit, heavily-regulated insurance companies. And other countries, like the UK and Canada, don't require citizens to buy insurance. Instead, citizens are covered as a birthright — by a single government payer in Canada, or by a national health system in the UK. The producers of the Frontline piece had a point of view — they wanted to keep the for-profit health insurance companies in the game," he claimed.

The Reid Factor

Mokhiber then quotes Reid as saying: "We spent months shooting that film. I was the correspondent. We did our last interview on January 6. The producers went to Boston and made the documentary. About late February I saw it for the first time. And I told them I disagreed with it. They listened to me, but they didn't want to change it."

Reid has a book coming out on this subject this summer titled "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care."

"I said to them — mandating for-profit insurance is not the lesson from other countries in the world," Reid said. "I said I'm not going to be in a film that contradicts my previous film and my book. They said — I had to be in the film because I was under contract. I insisted that I couldn't be. And we parted ways."

"Doctors, hospitals, nurses, labs can all be for-profit," Reid said, according to Mokhiber. "But the payment system has to be non-profit. All the other countries have agreed on that. We are the only one that allows health insurance companies to make a profit. You can't allow a profit to be made on the basic package of health insurance."

"I don't think they (Frontline) deliberately got it wrong, but they got it wrong," Reid said, adding that "it's perfectly reasonable for people to disagree about health policy." But Mokhiber then concluded: "It might be perfectly reasonable for people to disagree about health policy. But it's not perfectly reasonable to mislead the American people on national television in the middle of a health care crises when Congress is shaping legislation that will mean life or death for the for-profit health insurance industry."

As I mentioned earlier, the widely reproduced Mokhiber article produced a second round of critical mail. I asked both Frontline and Reid for more details about their differences, and those are included below, along with a sampling of the letters to me from either viewers or advocates.

But at this point, I'd like to inject my reactions.

My First But Not Final Thoughts

My initial reaction to the broadcast, as a lay viewer, was that this was a not-very-controversial documentation of horror stories about how bad our existing mixture of health care coverage can be for many people, and how good it can be for some others — if you happen to work for Microsoft, for example, which has excellent health care benefits for its employees. The program seemed, on the one hand, to be recording, with Frontline's usual dose of drama and expertise, something very timely but also something that we all already know. Yet it didn't tell me anything that I didn't know, although it did use phrases, such as "guaranteed issue" that I hadn't heard before and confused me.

So I actually did not think much more about the program until the first round of critical letters began arriving from those taking strong exception to the omission of any mention of the single-payer system.

As I looked further into this, I was struck by a couple of things. The program, itself, was largely ignored by television critics in major newspapers, perhaps a reflection that it had little impact and few, if any, new insights. The one large paper that I saw that did review it was the Los Angeles Times, and reviewer Mary McNamara concluded by saying that the broadcast "remains very hazy, offering scattershot examples of a far too familiar problem and very little in the way of solutions, or even hope." I thought that said it rather well, although this review also never mentioned single-payer.

A much more critical and extensive review was found in the Columbia Journalism Review. Writer Trudy Lieberman described it as a "limp, flat journalistic effort that did nothing to help the public understand the current politics of health reform." In the end, she said, "it just made for a confusing and unfulfilling hour of television, and made me think that Frontline missed an opportunity to say something meaningful and new about the topic at hand."

In that review, as well, there was no specific mention of "single-payer," although its concept was described. As I looked further, I found a brief but fascinating study last month by the media watchdog group FAIR (Fairness & Accuracy In Reporting) that documented how rarely major newspaper or broadcast or cable television stories actually mention the idea of a single-payer system as a part of the national dialogue, despite considerable support in polls and among a fair number in Congress. Only 18 out of hundreds of stories surveyed in one week dealing with health care reform mentioned it.

So, belatedly, I find myself in agreement with those who wrote initially and who felt it was a missed opportunity by Frontline to shed some light on where this specific idea — clearly telegraphed in the previous program about how other countries do it, enjoying some level of popular and professional support and formalized in a bill before Congress — stood in today's political environment.

As for the dispute over Reid's in and then out status, here is what Frontline most recently had to say to me in response to Reid's comments as reported by Mokhiber.

Frontline Responds, Vigorously

"FRONTLINE takes a strongly different view of the characterization of its editorial disagreement with T.R. Reid as presented by Mr. Reid and Russell Mokhiber in the recent blog entry, 'Something is rotten at PBS.'

"That blog entry describes the dispute about FRONTLINE's 'Sick Around America' as a disagreement about the correct health care policy for the United States and says that FRONTLINE 'had a point of view — they wanted to keep the for-profit health insurance companies in the game.' Those claims are not true and falsely characterize the reporting in the film.

"'Sick Around America,' in fact, made no assertions about the path health care reform should take, but simply reported on the current state of health insurance in the country, focusing primarily on how inadequacies in the current private health insurance system, both for-profit and non-profit companies, were negatively impacting many Americans. Our reporting revealed that both non-profit and for-profit insurance companies were concerned with keeping costs down and maximizing their market share. As a result both write policies that can be changed yearly based on the experience of the particular business in the case of employer-based coverage and both use medical underwriting (in all but five states) to reduce the number of sick or potentially sick individuals they cover. Both employ the practice of rescission, as we reported."

The Frontline response, at this point, goes on to challenge what it calls Mokhiber's "erroneous critique" of one portion of the film involving Karen Ignagni. That can be read online, along with this whole response, on Frontline's Web site but it is omitted here for space reasons.

Frontline's Response Continues:

"FRONTLINE sees the dispute with Mr. Reid as one not about for-profit vs. non-profit health insurance or health care policy, but instead about journalism. The dispute with Mr. Reid centered on a decision to include a section on the recent attempts by Massachusetts to reform its health care system. Mr. Reid objected to the inclusion of Massachusetts, the only state to require its citizens to purchase health insurance, and to require insurance companies to sell them policies with an adequate standard of coverage.

"Reid repeatedly told FRONTLINE that including Massachusetts in the program at all, was to advocate for that kind of reform as opposed to Reid's preference of a 'Medicare for all,' one-payer system for the entire country. FRONTLINE's position was that simply reporting on the state's plan was not advocacy and, in fact, our reporting would focus not only on the benefits, but also on the problems with the Massachusetts plan. We think any objective viewing of that sequence in 'Sick around America' will confirm FRONTLINE's view that it was a piece of reporting not advocacy.

"Editorial disagreements are common in the making of documentary films, but for more than twenty five years, FRONTLINE has been able to find a way to resolve those differences with a wide variety of producing and reporting teams. We were surprised to be unable to find consensus with Mr. Reid and found him resistant to working through the problems with us. He refused to travel to Boston to conduct a critical interview with the Massachusetts Secretary of Health or to have requested face-to-face meetings on his editorial differences with the FRONTLINE team. Instead, Mr. Reid demanded that he be completely removed from the film and FRONTLINE reluctantly honored his request."

Jumping the Line?

"We would also note that on March 17, just three weeks after he asked to be removed from the film, a Denver magazine reported that T.R. Reid said he was interested it being appointed to a vacant seat in the Colorado House of Representatives, citing that his concerns about health care reform in the U.S. were 'enough to push him from the reporting side over to the policy-making side. And he thinks Colorado would be a perfect testing ground.' FRONTLINE's editorial guidelines explicitly state that 'when working on any politically controversial programs the producer [or correspondent] should engage in no personal political activities . . . and should not lobby for or against any specific piece of legislation.'

"In the end, FRONTLINE believes the dispute centered on a conflict between FRONTLINE's journalistic commitment to fair and nuanced reporting and its aversion to policy advocacy and Mr. Reid's commitment to advocacy for specific health care policy reforms, for positions he apparently advocates in his forthcoming book.

"One last point: Mr. Mokhiber writes that Mr. Reid 'did the reporting for the film.' In fact, as is true in most FRONTLINE films, virtually all of the detailed reporting for 'Sick Around America' was conducted by the film's producer, Jon Palfreman, and his co-producer Kate McMahon. Mr. Reid consulted with Mr. Palfreman and conducted some of the interviews. However, Mr. Palfreman conducted many of the other interviews in the film. As is always the case, this was a collaborative journalistic effort. We regret that the collaboration had such an unfortunate conclusion."

Reid Responds, Vigorously

Here's what Reid had to say to me:

"Since 2006, I've been working on a book that explains how other rich countries manage to provide universal health coverage but spend half as much as we do. People are listening to me, because I've done more reporting than just about anybody when it comes to foreign health care systems. FRONTLINE made two good films of me reporting this book: 'A Second Opinion,' and 'Sick Around the World.' We worked well together, and the producers listened to me on health policy issues.

"I thought that would be the pattern on 'Sick Around America' as well. But the producer, Prof. Jon Palfreman [he's a professor of broadcast journalism at the University of Oregon], wrote the film without consulting me. He and Mike Sullivan spent weeks editing the film without consulting me. When I finally saw their product, about mid-February, I told them it was wrong as a matter of health policy. In late Feb., I wrote a revised script. Rejected. I then proposed 16 specific changes to the Palfreman script. Rejected. On Feb. 21, I suggested we delay the broadcast so that we could fix the problems with the film. Rejected.

"My position — as you've seen in the news stories — is that 'it's perfectly legitimate to disagree on health policy.' But it wasn't legit to make me appear in a film that I disagreed with. Eventually David Fanning, the boss of FRONTLINE, called me from China to say I would not have to appear if I disagreed with the film. I was grateful for that, although it leaves me with nothing to show for months of hard work.

"I admire the people at FRONTLINE. But I'm less sympathetic than perhaps I should be about the bad reviews and harsh criticism they've received for 'Sick Around America'. That's because I warned FRONTLINE about the reaction they'd get if they broadcast the film they had made behind my back. I told them that if they wanted to consider health-care solutions, they ought to mention several approaches including Medicare for all, single-payer, and the John McCain consumer-driven model. They refused. The only solution they mentioned was mandating people into private insurance. So I don't think the problems with this film are my fault.

"I was struck by one of the explanations that FRONTLINE posted on the web site for 'Sick Around America' in response to all the criticism. It says: 'America's for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.' That thought comes right out of the script I wrote for the film; but it's not in the film.

"I'm amazed at the long, angry screed FRONTLINE has posted as its 'extended response.' A lot of it seems factually wrong to me. There's no point trying to correct everything. But one point is important: Contrary to what the 'extended response' says, I don't see 'Medicare for all' as the solution to our health care mess. Instead, I'm looking for a politically viable route to the goal of universal coverage at reasonable cost."

I Respond, Not So Vigorously

It seems to me that the best solution here would have been for Frontline to resolve this by interviewing Reid for the program (although I have no idea if both sides would have agreed), thereby taking advantage of his reporting and allowing leeway for the conclusions that could be drawn from that reporting.

One, of course, can't get into the head of producer Jon Palfreman or the Frontline team to know if, deep down, there was some bias at work when it came to their views or Reid's views and any would-be solution to the medical care issue. Palfreman was the producer of the earlier "Sick Around the World" with Reid as correspondent and co-writer and that seemed to work.

I did not come away from this program, however, feeling that Frontline had somehow sold-out to the for-profit health insurance companies. Maybe as a lay viewer, I missed the subtleties. But years of watching Frontline does not suggest to me that they are soft on special interests. On the other hand, as independent critics have said, and I agree with, this program was indeed less impressive that what one has come to expect of Frontline and missed an opportunity to carry viewers forward in their thinking and understanding. My guess is that if a way had been found to keep Reid involved he would have sharpened the content and value of the program.

As for my friend (I hope that is still a fact) Tom Reid, I think he emerges in this post-broadcast episode as a reporter who, after years of reporting, has some clear views about achieving universal health care in this country. That is not unusual for any journalist who drills into any subject long enough. But there is then a tricky line that requires reporters not to become advocates. My guess is that the evolution of Reid's reporting-based views, along with the forthcoming book and the quest for that seat in the Colorado House of Representatives (not successful), tipped him over that line and into that reporter/advocate status. That would be a legitimate problem for Frontline. Or it could be an excuse. Let's hope that it was the former and that's all there was to this.

Here Are a Few of the Letters

Concerning Frontline's program Sick Around America, I am very distressed at the biased perspective presented by Frontline and by PBS in favor of keeping for-profit health insurance companies in the game.

It is my understanding that PBS had asked T.R. Reid to make this documentary as a follow-up to his outstanding Sick Around the World. Then after he'd done all the work you excluded his bottom-line perspective when the show aired — namely, that the U.S. should not let health insurance companies profit from selling basic health coverage. The only perspective you showed was that of Karen Ignagni, president of America's Health Insurance Plans, lobbyist for the industry.

It is both appalling and highly unreasonable for PBS and Frontline to mislead the American people on national TV by purposely disallowing Reid's point of view. Single Payer health care, which has saved me and so many others senior citizens and which COULD cover everybody, deserves full presentation and consideration as Congress approaches decisions in this crisis situation.

Mary B. Strauss, Oakland, CA

I'm writing to protest the shameless, pro-insurance corporation bias in your presentation — or should I say "infomercial" (complete with industry talking heads) "Sick Around America." PBS manipulatively doctored T.R. Reid's carefully documented investigation and conclusion, favoring a single payer, not-for-profit health insurance system, to favor exactly the contrary point of view. Thus, you are continuing the grand old tradition of "embedded" corporate media of shutting out points of view that don't square with the "acceptable" (i.e., corporate) parameters of debate.

The "only" solution is to disband the for-profit health insurance industry and institute a government-run, single payer, not-for-profit system of health care, such as that implemented in the UK, Canada, and elsewhere. Contrary to your mendacious presentation, in most countries where health care is a public right, purchase is not mandated, but rather health care is assured as an entitlement.

Michael Friedman, Hewlett, NY

Regarding Ms. Wright's "explanation" for the complete exclusion of "single payer" in the recent Frontline "Sick Around America:" Mr. Reid filmed and narrated "Sick Around The World" last year and it was a great success. According to FAIR and Corporate Crime Reporter, Mr. Reid had a contract with Frontline and helped film it but was not allowed to air his conclusions. Frontline claims that he was biased. It sounds like he quit because he was being muzzled. Ms. Wright's explanation was weak at best. I still did not hear why there was no mention of "single payer" in concept, which smacks of biased reporting. Frontline has let the public down. I used to have more respect for the program.

Portland, ME

Why was the "documentary" Sick Around the World, presented on Frontline, missing the voice of the gatherer of the information, reporter T. R. Reid? Why was his material re-directed with misinformation which enhanced the health insurance industry in a false manner? Why should I support PBS when you are pandering to corporate sponsors via the last administration's illusory machinations?

Mary S. Reader, Middletown, NY

Your "Sick Around America" seemed to be intentionally cooked to push the insurance based healthcare system and mandates for insurance and corporate welfare. You did not even mention single payer and mischaracterized other plans in other countries. How disappointing, if not malevolent.

Ed Cloonan, Munhall, PA

I strongly believe PBS owes the public an explanation (as well as one to T.R. Reid) on why single-payer and a not-for-profit basic healthcare package isn't the healthiest alternative for the sick system we have now, which "insures" that profits will be first over people's health. Shareholders' profits are not more important that people living and dying!! PBS needs to address this grievous error and omission as soon as possible if it is to truly represent the public good.